c157
Which of the following is the LEAST effective safety approach for a patient-centered healthcare organization to take? (A) Urge employees to do it right the first time. (B) Establish a quality council that includes patients. (C) Implement team-building throughout the organization. (D) Examine processes and establish controls to increase efficiency, reliability, and safety.
(A) Urge employees to do it right the first time.
By focusing on the patient, we can achieve the IHI Triple Aim. The Triple Aim is, simply stated, to create: (A) better outcomes, great patient experiences, and reduced costs (B) higher revenues, reduced turnover, and lower costs (C) lower revenues, higher costs, and lower patient satisfaction (D) better outcomes, reduced costs, and higher revenues
(A) better outcomes, great patient experiences, and reduced costs
Before selecting a vendor of a particular healthcare equipment or supply, the masters prepared nurse should do which of the following first? (A) Conduct vendor surveys. (B) Define departmental needs. (C) Determine which vendors are industry leaders. (D) Get feedback from team members about how various vendors and their supplies are performing (E) Decide which vendor is most cost effective.
(B) Define departmental needs.
Nursing leadership in a 750 bed tertiary care facility has been advised that quality measures affecting reimbursement are going to be captured to assess progress toward these goals, so a program is needed to improve the coordination of care as patients transition to other care settings. What role should the QI team have in a program to improve communication and care transitions? (A) Determine if current practice meets the metrics established for the measure or if this is a QI program needed to improve the quality of care delivered. (B) Determine whether facilities receiving patients are interested in a QI program initiated by the sending facility. (C) Check with patient families of discharged patients to ensure home care contacted them in a timely fashion and had the necessary information to provide high quality care. (D) Check each patient discharged for a two-week period to a skilled nursing facility or an assisted living facility to be sure the correct paperwork was sent or transmitted to the facility.
(B) Determine whether facilities receiving patients are interested in a QI program initiated by the sending facility.
Based on patient survey data that indicate patients were dissatisfied with the level of noise on the patient care unit, the QI team has recommended the use of a sound machine in each patient room to muffle the ambient noise on the unit. How should the MSN respond to this recommendation? (A) The MSN should serve as a champion & role model during the implementation of the recommendation. (B) The MSN should search the literature to confirm that the recommendation is evidence-based. (C) The MSN should support the recommendation, as it is an effort that will improve patient care. (D) The MSN should clarify how the data were collected and how the team developed its recommendation.
(B) The MSN should search the literature to confirm that the recommendation is evidence-based.
Which of the following is NOT an appropriate goal for quality improvement education of MSNs? (A) Develop an understanding of the fundamentals of quality. (B) Integrate quality into decision-making processes. (C) Define the chain of command for approving quality procedures. (D) Provide tools and information to help MSNs build and utilize quality systems and processes.
(C) Define the chain of command for approving quality procedures.
Which of the following is the first priority when starting a quality improvement initiative? (A) Assign team goals. (B) Develop strategies. (C) Identify an aim. (D) Make sweeping organizational changes to support quality.
(C) Identify an aim.
Which of the following is one advantage of team decision-making? (A) Ease of arriving at a decision (B) Reduced potential for conflict (C) Increased acceptance of decisions (D) Increased productivity
(C) Increased acceptance of decisions
Historically, which group is closely aligned with the financial success of healthcare organizations and therefore is designated the leader for most clinically-based innovations? (A) Nurses (B) Administration (C) Physicians (D) Admitting
(C) Physicians
The wide scale collection of patient weight into a large dataset is primarily used to measure and improve healthcare for which type of group? (A) Family health (B) Extended family health (C) Population health (D) Individual health
(C) Population health
. In order to be successful in the role of change agent, an MSN should do all but one of the following? (A) Understand and respect peoples' needs. (B) Learn from previous unsuccessful efforts to transform the organization. (C) Maintain commitment to the mission and vision of the organization. (D) Communicate change initiatives only to senior management.
(D) Communicate change initiatives only to senior management.
Which of the following is a priority for the MSN in planning quality improvement training? (A) Establishing specific training evaluation tools. (B) Developing short-term training plans. (C) Scheduling training for managers. (D) Connecting training to organizational needs.
(D) Connecting training to organizational needs.
An MSN wants to implement Leadership Rounds in the hospital, to include participation of the CEO. This initiative would provide an informal way for senior leaders to talk with front-line staff about safety issues in the organization and to encourage reporting of errors. All of the following are benefits of having the CEO involved in these rounds EXCEPT (A) Increased understanding by the CEO of the organization's state of affairs. (B) Improved motivation of subordinates through personal participation of the CEO. (C) Improved human relations between the CEO and front line staff. (D) Improved dissemination of information throughout the organization.
(D) Improved dissemination of information throughout the organization.
A patient's right to make informed decisions includes all of the following except: (A) Right to participate in the development of his/her plan of care. (B) Right to consent to treatment. (C) Right to refuse to consent to treatment. (D) Right to receive care that is not medically necessary. (E) Right to participate in planning for post-hospitalization care.
(D) Right to receive care that is not medically necessary.
A primary care provider refers a patient to a specialist. The specialist treats the patient and then sends the patient with a report back to the primary care provider. A manual (paper-based) system was used in this referral process. Which of the following statements about manual systems is true? Manual systems for referrals or other transitions in care: (A) Decrease the complexity of the referral process and reduce opportunities for human error. (B) Often result in more efficient work-flow processes. (C) Never result in missed appointments and lost revenue. (D) Are known to reduce delays in patient care. (E) Often involve no agreement on who is responsible for closing the loop (ensuring that referral information is exchanged provider-to-provider).
(E) Often involve no agreement on who is responsible for closing the loop (ensuring that referral information is exchanged provider-to-provider).
When is it appropriate to collect and use data
1. Before the QI project, to prove a problem exists. 2. During the QI project, to answer questions about the cause and help prioritize the implementation of improvements. 3. After the implementation of the improvement to maintain the gain
Four strategies that promote staff empowerment
1. adopting a shared vision 2. team building 3. relinquishing administrative control 4. rewarding performance that adheres to high standards.
59. The surgery department's monthly case review revealed twenty-six records meeting the criteria. Six records did not meet the criteria. When calculating the incidence risk, the denominator is a. 6 b. 20 c. 26 d. 32
32: This is a thought problem—it is telling you that 26 records in the review did meet criteria (compliant records), so you can't have 6 records out of that 26 that also did not meet criteria (noncompliant records). So the 6 records that did not meet criteria would be an additional amount (6 records that did not meet criteria + 26 records that did meet criteria = 32 total records). The denominator in a calculation of rate is always the total number in the group being examined.
Place in order: Steps in training design 1. Prepare training materials. 2. Define training objectives. 3. Determine course structure and sequence. 4. Establish consensus on needs.
4. Establish consensus on needs. 2. Define training objectives. 3. Determine course structure and sequence. 1. Prepare training materials.
To be effective, quality initiatives must be (A) Developed by stakeholders. (B) Free from cost and profit considerations. (C) An integral part of the overall organizational strategic plan. (D) A&C (E) All of the above
A) Developed by stakeholders. (C) An integral part of the overall organizational strategic plan
Which Quality and Safety Education in Nursing (QSEN) statement is an attitude that the master's-prepared nurse must develop in order to practice patient-centered care? A. Commit to the patient being the source of control and full partner in their own care B. Identify and create plans to address barriers in care settings that prevent healthcare providers from fully integrating patient-centered care C. Analyze the factors that create barriers to patient-centered care D. Work with patients to create plans of care that are defined by the patient
A. Commit to the patient being the source of control and full partner in their own care
The process improvement data on a general medical unit documents that 20% of the patients 75-years-old or older who were admitted to the unit during the last six months experienced a patient fall.When implementing a process to address patient falls, what should the master's-prepared nurse do first? A. Compare the current data about patient falls to the previous year's data B. Determine the percent of admitted patients who are 75-years-old or older C. Implement a staff education project about how to prevent patient falls D. Identify which nurses are providing nursing care for patients who fall
A. Compare the current data about patient falls to the previous year's data
Based on data from the last three months, the current rate of hand hygiene compliance on a nursing care unit is 80%. The unit goal is 95%.To address hand hygiene compliance, what should a master's-prepared nurse do next? A. Compare the current hand hygiene compliance data to the data from the previous three months B. Place hand hygiene reminders outside each patient room and by each sink on the unit C. Observe hand hygiene practices to determine which staff are not being compliant D. Provide incentives to staff who routinely complete their hand hygiene
A. Compare the current hand hygiene compliance data to the data from the previous three months
After a year of process improvement activities, a surgical unit decreased its surgical site infection (SSI) rate to 1.2%. The national rate of SSI is 2.5%, and the unit's goal was to have an SSI rate of less than 2%.What is the next step in the improvement process? A. Continuing process improvement activities and monitoring of the SSI rate B. Identifying new process improvement goals and activities for the unit C. Changing the SSI goal to 0.5% to be accomplished within the next year D. Examining the data to determine which surgeon has the best SSI rate
A. Continuing process improvement activities and monitoring of the SSI rate
How should a director of nursing respond to the national quality goal of improving the quality of care transitions and communication across care settings? A. Create a task force comprised of nursing administration, charge nurses, discharge planners, and staff nurses B. Utilize primary source materials, and research to determine best practices for care transitions and communication across settings C. Consult with the medical director to identify the communication needs of providers in the transition of care D. Enforce existing policies for continuity of care, and create a process to determine compliance through documentation audits
A. Create a task force comprised of nursing administration, charge nurses, discharge planners, and staff nurses
The quality improvement team is working together to identify the primary drivers of patient satisfaction regarding the nursing care the patient's receive. One of the identified primary drivers of patient satisfaction was effective communication.What is the first thing the quality improvement team should do with this information? A. Establish a means for measuring effective communication B. Develop strategies for teaching effective communication C. Implement a national program for effective communication D. Remind staff of the importance of effective communication
A. Establish a means for measuring effective communication
A nursing director of a home healthcare agency notices that a high rate of documentation errors have been made in the past year.Which intervention is an appropriate step of the evidence-based practice process to reduce documentation errors? A. Evaluate evidence from research regarding documentation errors B. Purchase documentation software to facilitate decreased error rates C. Direct the nurse educator to provide documentation education for staff D. Consult with the state board of nursing regarding ways to improve documentation
A. Evaluate evidence from research regarding documentation errors
What must a nurse ensure has been considered before implementing an innovation in care provided to adult patients? A. Patient desires B. Family preferences C. Staff qualifications D. Administrative expectations
A. Patient desires
A healthcare organization is collecting data about the quality and safety of the nursing care provided within the organization. Consistent with the national priority of promoting effective coordination of care, which dataset should the nurse use to substantiate the need for changes in patient care processes? A. Patient readmissions for patients discharged to long-term care facilities, increasing from a readmission rate of 3% (six months earlier) to a rate of 4% (current) B.Patient survey results indicating only 66% of patients surveyed were satisfied or very satisfied with the quality of discharge education they received C. Root cause analysis of an event where a patient fell after being transferred to another unit, indicating nurses did not follow transfer protocols D. Nursing staff survey results indicating only 70% of the nursing staff believe that the current protocols related to coordination of care are effective
A. Patient readmissions for patients discharged to long-term care facilities, increasing from a readmission rate of 3% (six months earlier) to a rate of 4% (current)
Which approach should the nurse manager employ to create an environment that encourages innovations toward evidence-based nursing care? A. Providing nursing staff with resources and opportunities for the implementation of evidence-based nursing practice B. Requiring nursing staff to participate on clinical practice committees, which develop evidence-based unit policies C. Purchasing subscriptions to evidence-based clinical practice journals for the nursing staff on the unit D. Modeling evidence-based nursing inquiry and scholarship, in addition to maintaining clinical expertise
A. Providing nursing staff with resources and opportunities for the implementation of evidence-based nursing practice
Which benchmark domains must be considered when evaluating evidence for use in a healthcare setting innovation? A. Quality, quantity, and consistency B. Selection, type of studies, broad results C. Quality, differing types of studies, narrow results D. Biases, quantity, usefulness of results
A. Quality, quantity, and consistency
How can a master's-prepared nurse best demonstrate respect for the various views that members of the healthcare team may have? A. Seek to understand the perspectives of all team members B.Act as the primary advocate for the patient's preferences C.Avoid conflict by deferring to the team leader whenever possible D.Articulate nursing ideas and perspectives clearly and concisely
A. Seek to understand the perspectives of all team members
When working with an inter-professional team, what should the nurse do if the nurse is not certain that the assignment is consistent with the nurse's personal values? A. Speak with the team leader about the values conflict B. Work with the team members to propose a new direction C.Resign immediately from the inter-professional team D. Convince the team members that the nurse's perspective is correct
A. Speak with the team leader about the values conflict
Which statement best describes why graduate-level academic preparation is important for nurses to have? A. The dynamic and complex nature of healthcare requires expanded knowledge and understanding of nursing theory and practice.B. The reimbursement formulae in the Affordable Care Act in the United States require nurses to be prepared at the graduate level. C. The patients and their caregivers have an expectation that their nursing care is provided by nurses holding master's degrees. D. The profession of nursing is implementing requirements that nurses hold graduate degrees for licensure and practice in nursing
A. The dynamic and complex nature of healthcare requires expanded knowledge and understanding of nursing theory and practice.
Which information should the nurse use to justify the implementation of a mobile healthcare clinic for rural healthcare delivery? A. The organization serves rural communities where much of the population does not have access to reliable transportation. B. The availability of parking at the organization is limited, and patients have reported the need to use a valet rather than parking themselves. C. The healthcare providers want to apply for a grant from a healthcare foundation that funds outreach programs for rural health access. D. The Centers for Medicare and Medicaid have identified the need to improve access to healthcare for Americans living in rural areas.
A. The organization serves rural communities where much of the population does not have access to reliable transportation.
A master's-prepared nurse is leading a quality improvement team in the development of a new admission process for a healthcare organization. The team has determined what constitutes best practices for admissions and has developed its recommendations.What should the team do next? A. The team should complete a pilot test of the new admission process. B. The team should work with clinical educators to roll out the new process. C. The team should develop information sheets about the new admission process. D. The team should propose an organization-wide implementation of the new process.
A. The team should complete a pilot test of the new admission process.
A patient receives a deep dermal burn during surgery.What should the nurse anticipate after the process improvement team performs a root cause analysis? A. The team will develop recommendations to prevent future occurrences B. The team will identify the staff members responsible for the event. C. The team will establish revised surgical protocols and processes. D. The team will collect national data related to this type of event.
A. The team will develop recommendations to prevent future occurrences
What is the primary reason nurses should engage in process improvement? A. To improve patient care B. To decrease healthcare costs C. To document quality healthcare D. To meet accreditation standards
A. To improve patient care
What is the primary reason for the need of national standards that describe the roles and responsibilities of the master's-prepared nurse? A. To provide a framework for developing the skills and competencies required by master's-prepared nurses B. To ensure that master's-prepared nurses receive the same educational experience and preparation C. To guide the development of nurse practice acts and regulatory requirements for practice D. To demonstrate to the public that nurses possess unique professional knowledge and skills
A. To provide a framework for developing the skills and competencies required by master's-prepared nurses
An interprofessional team comprised of a hospitalist, nurse practitioner, pharmacist, registered dietician, social worker, and discharge manager, are caring for a six-year-old patient being treated for status asthmaticus. Prior to admission, the patient required several recent emergency department (ED) visits and hospitalizations with missed outpatient subspecialty appointments. The patient was noted to be overweight, and nutrition counseling was provided at the last outpatient appointment.Which aspect of the patient's care should be the priority for the nurse practitioner? A.Work collaboratively with each member of the interprofessional team to address the patient's health concerns B.Refer the patient to a respiratory specialist to assess the parent's understanding of the asthma action plan C.Ensure the interprofessional team focuses on the patient's adherence to the weight management and nutritional counseling plan D. Consult with the social worker to address the frequent ED visit and hospitalizations with multiple missed subspecialty appointments
A.Work collaboratively with each member of the interprofessional team to address the patient's health concerns
Which representatives of a CV practice should be included on a quality improvement team to implement a new practice
All staff directly affected by the quality improvement practice to be implemented.
Effective quality improvement does not require
An increased emphasis on inspection of individuals work.
A patient has a terminal illness. Against the family's wishes, the patient requests a "do not resuscitate" order. Which ethical principle supports the patient's decision
Autonomy
In reflecting on the role of MSN mentor, which of the following statements is not true? (A) The mentor nurtures and develops the mentee's capacity for self-reflection and self-direction. (B) Mentoring relationships are task focused; when the tasks are completed the relationship comes to a close. (C) A mentor who understands how to provide vision and how to support and challenge the mentee can help the mentee grow and develop. (D) The mentoring relationship is a learning partnership that focuses on developing the mentee's abilities and thinking. (E) Some preceptors are also mentors; being a mentor is not dependent on being a preceptor.
B) Mentoring relationships are task focused; when the tasks are completed the relationship comes to a close.
A healthcare organization has been collecting data about the quality and safety of the nursing care provided within the organization.Consistent with the national priority of ensuring that each person is engaged as a partner in care, which dataset should the nurse use to substantiate the need for changes in patient care processes? A. Patient satisfaction survey results indicating only 62% of patients surveyed would recommend the healthcare organization to a family member needing healthcare B. A report from a patient/nurse focus group indicating patients do not feel they are adequately included in making decisions regarding their healthcare C.A nursing staff report indicating that patients are involved in decision-making about their healthcare approximately 75% of the time D. A survey administered to some patients prior to discharge indicating that 70% of the patients surveyed had been involved in making healthcare decisions
B. A report from a patient/nurse focus group indicating patients do not feel they are adequately included in making decisions regarding their healthcare
An acute care facility is experiencing increased admissions of morbidly obese patients. The facility does not have sufficient patient-lifting equipment.What should the advanced practice nurse do first to begin a 'Plan Do Study Act' (PDSA) cycle for this facility? A. Provide adequate resources and education for nursing staff B. Delegate the role of project leader for the project in the facility C. Evaluate the results of the interventions and report back to the staff members D. Select the interventions to be implemented and delegate them to the staff members
B. Delegate the role of project leader for the project in the facility
The nurse manager is concerned that nurses may not be following proper hand washing guidelines and wants to improve practice. The nurse decides to focus on a major area to improve quality and performance for this skill.Which area should be addressed to improve hand hygiene practices? A. Motivation B. Leadership C. The people fallacy D. Information related to work projects
B. Leadership
Of the following, two statistics are essential for identifying opportunities for performance improvement. These are: a. Frequency counts and modes. b. Variance and distributions. c. Mean and median values. d. Data ranges and standard deviations
B. Variance and distributions
After assessing current work flow and processes, a clinical team presumes that a delay can occur anywhere along the process of their tasks. Data is inadequate at this point to identify a particular time of day, day of week, type of patient, and/or step in the process that is largely responsible for the delays. Further data collection is necessary. What should the team "product" be for the next meeting? a. A prioritization matrix. b. A finalized data collection tool and instruction sheet for implementation. c. A list of questions to be answered and a draft data collection tool. d. A listing of possible solutions.
C. A list of questions to be answered and a draft data collection tool.
A novice nurse is caring for a patient who has been pronounced brain-dead. The patient has a signed advanced directive in the chart. The MSN nurse models for the novice nurse how to approach the family to implement the patient's wishes regarding organ donation.Which principle of ethical decision making is being demonstrated? A. Justice B. Fidelity C. Autonomy D. Beneficence
C. Autonomy
As a building block for determining whether or not quality has been improved, the use of basic descriptive statistics in applying QI is critical. Which of the following is not a strictly quantitative description of the basic features of a study? a. Mean data values. b. Frequency counts. c. Hospital ratings. d. Standard deviations.
C. Hospital ratings
An advanced practice nurse for the nursing unit in a hospital identified the problem of increased sepsis rates related to intravenous lines.Which step represents the Act component of the Plan Do Study Act (PDSA) cycle for the process improvement team? A. Compare sepsis rates to rates found on other units B. Culture intravenous insertion site on the unit patients C. Review antibiotic therapies of patients throughout the hospital D. Review the literature for evidence-based guidelines for sepsis care
C. Review antibiotic therapies of patients throughout the hospital
The nurse manager in a pediatric emergency department (ED) believes that there is a pattern of delay when administering the initial dose of prednisone for patients being treated for status asthmaticus. What is an appropriate evidence-based approach for the nurse manager to take when addressing this identified system failure? A. Consult with managers from other EDs to determine the standard of care B. Meet with nurse administrators to identify contributing factors to this issue C. Use analytical methods to critically appraise existing literature for this diagnosis D. Delegate to the pediatric nurse educator to train staff to reduce time to first dose
C. Use analytical methods to critically appraise existing literature for this diagnosis
An advanced practice nurse for a nursing unit in a hospital has identified the problem of sepsis.What is the next step in the Plan Do Study Act (PDSA) cycle? A. Evaluate changes in patients' conditions B. Complete thorough assessment and collect data C.Implement the Institute for Health Improvement guidelines for sepsis D. Implement the sepsis interventions that are easily accessible on the nursing unit
C.Implement the Institute for Health Improvement guidelines for sepsis
Quality in QI refers to
Characteristics of a product or service that bear on its ability to satisfy stated or implied needs
special kind of run chart that helps us determine if a process is out of control or not
Control chart
An interprofessional team is being assembled by a MSN to address the complex issues of pediatric patients with severe persistent asthma.What is a role of this MSN to facilitate effective team functioning? A. Emphasize the nursing impact on pediatric asthma B.Develop individual goals related to asthma exacerbation C.Eliminate system barriers for the pediatric healthcare team D.Encourage interprofessional team dynamics in planning asthma care
D.Encourage interprofessional team dynamics in planning asthma care
The first step in problem solving is to
Define the problem issue
Comparisons of your data against the top performers in your region/industry describe the process(es) of:
External benchmarking
Most helpful in identifying a problem in a process that could benefit from a quality improvement strategy.
Flow Charts
illustration of the steps in a process
Flow chart
Which ethical conflict places the equitable access to health care against actions that produce the greatest good
Justice vs. Utilitarianism
59. Which of the following statistics best describes the central tendency of a sample of data? a. Mode b. Mean c. Standard deviation d. Range
Mean
A leadership style that is said to motivate employees, and that optimizes the introduction of change is:
Participatory - An approach where leaders interact with other participants as peers, engaging them in the decision-making process and playing an equal role in the process as others and jointly carrying out the problem solving activities.
Can help look at recurring events over a fixed timeframe
Poisson distribution
Quality Improvement assumes that...
Problems with service delivery results from process difficulties, not individuals.
The nurse executive is the chair of a new performance improvement team whose purpose is to address patient flow through the emergency department. A laboratory team member openly blames emergency department nurses for a long turnaround time in obtaining patient test results. To which phase of group development does the nurse executive attribute the blaming behavior? a. Forming b. Norming c. Performing d. Storming
Storming
The major difference between traditional "quality assurance" activities (e.g., keeping track of the total number of different procedures conducted in your practice, rates of adverse outcomes) and "quality improvement" activities is that quality improvement also focuses on:
Systems and processes
Benchmarking creates objective measures of performance that are based on
a. Past performance targets within an organization. b. Performance of a competing external organization. c. Some external universal performance target established by the industry
Which of the following describe examples of patient safety barriers? a. Persistent fear and hierarchical authority b. Complexity and deficient measures c. Reporting systems and safety culture—this is the only item that would support patient safety! d. Diffuse accountability and lack of leadership
a. Persistent fear and hierarchical authority b. Complexity and deficient measures d. Diffuse accountability and lack of leadership
31. If data are plotted over time, the resulting chart will be a (A) Run chart (B) Histogram (C) Pareto chart (D) Poisson distribution
a. Run chart
A well-designed patient safety program should include all of the following EXCEPT a. an annual patient safety committee meeting b. planned response to adverse events c. orientation and continuing education on patient safety issues d. review of patient safety policies and procedures for all departments.
a. an annual patient safety committee meeting
A 14-year-old female patient, who is a practicing Jehovah's Witness, is admitted for anemia. The physician determines that blood transfusions are necessary, but the patient's parents refuse to consent. The patient states that she wishes to be treated. The advanced practice nurse action is to: a. contact local clergy for assistance in crisis intervention. b. inform the patient that her parents must consent before treatment can be administered. c. inform the patient that she is a minor and incapable of such decisions under state law. d. request that the administration contact the hospital attorney for legal counsel
a. contact local clergy for assistance in crisis intervention.
Which of the following is MOST likely to be a benefit of concurrent ambulatory surgical case review? a. decreased medical record review at discharge b. an increase in the number of cases failing screening criteria c. an increase in reviewer competence d. decreased medical record requests
a. decreased medical record review at discharge
59. Which of the following monitors provides patient outcome information? a. healthcare-acquired infection rateb. nursing care documentation compliance c. antibiotic therapy discontinuation compliance d. equipment malfunction rate
a. healthcare-acquired infection rate
Based on observation, an NP believes that the rates of smoking and obesity are increasing in their patient population and wants to implement a program to address this issue in the ambulatory clinic. What is the 1st step the NP should take to determine if this belief is, in fact, a trend? a. work with the practice manager to determine rates of smoking and obesity in the practice b. ask the other staff if they are seeing increasing numbers of patients who are smoking and/or obese c. ask patients if they feel that either smoking or obesity is affecting their lifestyle d. work with the staff to counsel each patient on the dangers of smoking and the risk factors of obesity
a. work with the practice manager to determine rates of smoking and obesity in the practice
What is the primary purpose of a policy, as opposed to a procedure? a. A policy is binding in all circumstances to which the policy relates. b. A policy is broad and durable, designating actions for matters that frequently recur. c. A policy is designed to guide actions when managing exceptional situations. d. A policy is specific and detailed so as to avoid individual interpretation.
b. A policy is broad and durable, designating actions for matters that frequently recur.
59. Discharge planners regularly monitor the number of inappropriate referrals, the timeliness of discharge planning, and the number of days of discharge delays. What additional monitor should be added to evaluate the appropriateness of discharge planning interventions? a. adequacy of documentation in progress notes b. attainment of discharge planning goals c. timeliness of referrals to discharge planning d. number of discharge planning referrals from nursing
b. attainment of discharge planning goals
The nurse executive receives notice that critical supplies have not arrived before a three-day holiday weekend. Due to a computer system error, "just-in-time" supplies were not queued for delivery. The nurse executive's next action is to: a. conduct an internal audit of supplies, compared to patient usage and census, before requesting assistance from materials management. b. contact the materials manager to expedite the delivery of supplies before the end of the work day. c. direct the department managers to negotiate for needed supplies, and allocate resources according to department census. d. mobilize personnel to facilitate the purchase of needed supplies from the available vendors
b. contact the materials manager to expedite the delivery of supplies before the end of the work day.
The first step in a remedial action program for an employee whose clinical performance does not meet standards is to: a. determine whether the employee will be more receptive to self-learning modalities or referral to a staff development educator. b. determine whether the problem is related to a lack of competency or a lack of productivity. c. refer the employee to a staff development educator for further education and training. d. determine whether the problem is related to a lack of knowledge or a lack of skill
b. determine whether the problem is related to a lack of competency or a lack of productivity.
Pharmacy and Nursing are having difficulty developing an action plan for medication errors. Pharmacy Services states that Nursing Services cause the majority of the problems related to errors, while Nursing Services states the opposite. The QI department's role in resolving this problem is to a. provide them with directives on how to solve the problem b. facilitate discussion between the groups to enable them to assume ownership of their portions of the problem c. assign the task to an uninvolved manager d. refer the problem to the facility-wide quality council
b. facilitate discussion between the groups to enable them to assume ownership of their portions of the problem
Research suggests that a nurse executive most effectively improves employee job satisfaction by: a. increasing employee salaries. b. increasing staff autonomy. c. offering more educational assistance. d. providing a clinical advancement program.
b. increasing staff autonomy.
59. Flowcharts are primarily used in quality improvement to a. analyze causal factors of process dispersion b. understand the overall process or system being audited c. distinguish variations in a process over time d. determine process capability and uniformity
b. understand the overall process or system being audited
A nurse executive sponsors a multidisciplinary team that is charged with educating patients scheduled for total joint replacement surgery, about topics including what to expect after discharge. What is the nurse executive's response when encountering resistance from team members? a. Direct the mid-level managers to reemphasize the vision to their direct reports b. Encourage the first-level managers to reinforce the vision to the team members c. Gather together the various disciplines and listen to their concerns about the project d. Reeducate the team members about how their role affects the outcome of the team
c. Gather together the various disciplines and listen to their concerns about the project
Which statement is an outcome indicator for an educational strategy? a. The nurse working in a coronary care unit has successfully completed an advanced coronary care course. b. The nursing care plan outlines a strategy for each patient problem c. The patient names all medications to be taken after discharge. d. The patient who is newly diagnosed with diabetes receives 10 hours of instruction
c. The patient names all medications to be taken after discharge.
The data obtained for quantitative research would best be used for what purpose? a. To gain insight into cultural practices b. To investigate the "why and how" of decision-making c. To predict future clinical outcomes d. To understand the meaning of events
c. To predict future clinical outcomes
59. In what instance is it acceptable to obtain additional time for a corrective action? a. When the auditor cannot perform the audit as scheduled b. When the group being audited determines that the proposed corrective action is not cost effective c. When the corrective action plan requires more time than originally anticipated d. When there has been a change in personnel who perform the task
c. When the corrective action plan requires more time than originally anticipated
The QI team is working together to identify the primary drivers of pt satisfaction regarding the nursing care that patients receive. One of the identified primary drivers of pt satisfaction was effective communication. What is the 1st thing the QI team should do with this information? a. develop strategies for effective communication b. implement a national program for effective communication c. establish a means for measuring effective communication d. remind staff of the importance of effective communication
c. establish a means for measuring effective communication
A committee in a large urban hospital is appointed to plan improvements in patient care. The committee members include the: a. chief nursing officer and the chief medical officer. b. institution's strategic planning committee members. c. medical, nursing, and ancillary staff personnel. d. senior management and the budget adviser
c. medical, nursing, and ancillary staff personnel.
A surgeon's wound infection rate is 32%. Further examination of which of the following data will provide the MOST useful information in determining the cause of this surgeon's infection rate? a. mortality rate b. facility infection rate c. use of prophylactic antibiotics d. type of anesthesia used
c. use of prophylactic antibiotics
66. Which of the following requests is likely to obtain the most objective evidence for verification? a. "What kind of information do you receive?" b. "Who provides the information to you?" c. "Describe how you receive information." d. "Show me the information you have received."
d. "Show me the information you have received."
Which of the following concerns would be best solved by a QI team? a. A computer systems issue with linking the clinical database to the hospital ADT system. b. A discipline issue with a problem employee. c. An individual customer complaint regarding lengthy wait time. d. A financial variance in cost per left heart cath procedure over the past 6 months.
d. A financial variance in cost per left heart cath procedure over the past 6 months.
An MSN needs to assign a staff member to assist a medical director in the development of a quality program for a newly established service. Which of the following staff members is MOST appropriate for this project a. a newly hired staff member who has demonstrated competence and has time to complete the task b. a knowledgeable staff member who works best on defined tasks c. a motivated staff member who is actively seeking promotion d. a competent staff member who has good interpersonal skills
d. a competent staff member who has good interpersonal skills
59. A primary purpose of an information management system is to allow an organization to a. save time b. centralize demographics c. reduce cost
d. evaluate data
Which QI goal is most effective for the QI team to use? a. the pt satisfaction score will increase by 10% b. the pt satisfaction score will exceed national averages c. the pt satisfaction score will improve from 62% to 98% d. the pt satisfaction score will be 95% by December 1
d. the pt satisfaction score will be 95% by December 1
The nurse executive develops a balanced scorecard for nursing practice by emphasizing
internal and external benchmarks
Storming
—refers to the conflict-ridden stage of team development
Performing
—team members begin to obtain results
Norming
—team members begin to resolve differences
Forming
—the team is brought together
